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Physician Retreats Bust 'Conspiracy of Silence'

 |  By jcantlupe@healthleadersmedia.com  
   October 03, 2013

A group of Florida physicians opts to skip the golf course and instead, climbs an 11,000-foot mountain range to get away from healthcare. In the process, the doctors learn to work together and hone their leadership skills "under a carpet of stars."

In what Herdley Paolini, PhD, LP, PSS, the facilitator of Florida Hospital's Labor Day weekend camping trip called a "leadership development retreat," 10 doctors took 15 hours of continuing medical education while hiking 30 miles in the woods and mountains at Flat Tops in Colorado, about 200 miles due west from Boulder.

At one point, they had to trudge seven miles while running low on potable water. Some of them had never camped before. No computers, cell phones, or electronic devices were allowed on the trip. Pen and paper were allowed.

The physicians learned to depend on each other. "Just seeing the bonds that developed was great," Paolini told me. "With doctors, sometimes there's this conspiracy of silence and nobody talks about things. Here, the resolve was great," Paolini says. "They were empowered and worked together, under a carpet of stars."

Paolini heads Florida Hospital's Physician Support Services in Orlando, FL, which sponsors several retreats every year for doctors. Paolini ran the program with co-facilitator Burt Bertram, EdD, LMFT, LMHC.

The doctors—all part of the Florida Hospital system—talked about healthcare against a beautiful natural backdrop. Do they have enough time for their patients? Are they fulfilling their expectations as part of a multidisciplinary team? After the camping trip, one participant wrote to Paolini: "I learned new ways to better myself, and improve my leadership skills, like deep listening and self-reflection."

Once they returned to their practices or the hospital, there were other more sobering realities waiting for them, like taking care of sick patients. But the Florida Hospital effort was a way of getting people together, and of emphasizing teamwork, for a group of medical providers who often rely too much on themselves, and don't reach out in a meaningful way, Paolini says.

Indeed, the alignment of physicians, as a team or especially with hospitals where they work or are employed, is challenging, and critical in healthcare, with the demands of evolving regulations, reimbursement cutbacks and the move toward value-based purchasing.

Months before the Florida doctors' long weekend camping trip, at a hotel in Nashville, TN, a separate group of hospital and healthcare executives got together at a HealthLeaders Media Roundtable  where the need for improved coordination among hospitals and physicians also came into focus. The panelists emphasized the importance of forming clinically integrated networks, with physician collaboration or involvement with hospital leadership essential.

"Whenever you are going into a clinically integrated network, that means partnership," said panelist Humayun Khan, MD, CMO for St. Joseph's Hospital and Sacred Heart Hospital, of the Hospital Sisters Health System in Western Wisconsin Division, in Eau Claire, WI. "Physician groups have typically been quite autonomous. Now to come into a partnership and try to meet certain goals is suffocating for many physician groups that we are dealing with."

The Hospital Sisters Health System has a large, independent physician organization, Khan says, that is on a path of building a clinical integration network. "I think this strategy is going to (help) us, not only with the care provided within the community, but also when we go into contracts with third parties," Khan said.

Having an employment model was important toward developing a medical staff and ensuring significant savings, observed another panelist, Rand Wortman, President & CEO of the Kadlec Health System in Richland, WA. Still, six years after putting together a team of 100 employed physicians, "We're still struggling with how do you put it together? How do you build the culture?" Wortman asked.

Not only do physicians have responsibilities in developing a proper culture environment, but so do hospitals, Wortman said. "I'm adamant that my team has to deal with physicians with respect," Wortman said. "Frankly, not all hospital systems do. Part of it is consistency in how the administration behaves or the institution behaves." Of doctors, he said, "When you deceive them, they never forget."

Two other panelists addressed the need to develop physician leadership abilities, and the fact that doctors have to work more closely with hospital administrators.

Physicians will not only have to get along with one another and their superiors, but more likely there will be a need to have better frameworks of care with mid-level providers, to fill more gaps in the system. "So that is definitely an area that I think will continue to be a problem," said Jordan Asher, MD, CMO and CIO of MissionPoint Health Partners in Nashville.

"It's absolutely critical as we go forward with whatever alignment strategies are, that we enable our physicians to be leaders," said Oliver Rogers, president of hospital-based services for TeamHealth in Knoxville, TN. "How do we jump-start the leadership skills for these physicians, because we don't have time for them to learn by the school of hard knocks? I think that emphasis on formal leadership training is going to be critical to this process of alignment."

Developing physician leadership seems to be one of the most difficult and important aspects of evolving care post healthcare reform, and is essential for clinical integration. I asked Carson F. Dye, co-author of the book, Developing Physician Leaders for Successful Clinical Integration about his feelings on the issue. There are many definitions of clinical integration, Dye wrote, but a "common theme emerges; quality improvement facilitated by physician engagement and leadership."

Dye sees clinical integration as a salvation of healthcare systems, citing a need for both physicians and hospitals to share in their work, technologically and clinically.

Physicians must get comfortable being partners with a hospital, especially about the business of number crunching. "While there are several elements that support successful clinical integration efforts, perhaps the most important one is the willingness of physicians to share quality data and consider the metrics that support quality improvement," Dye told me.

"Of course, this presumes a strong clinical data system and high integrity of data," Dye adds. Sharing the data "goes to the heart of the professional practice," he says.

Those healthcare organizations that have successfully improved their clinical integration practices are definitely willing to involve physicians "to a much greater degree in decision-making and operations," Dye says.

"On the flip side, the biggest failure at this time is organizations that do not see the physician as having a true place at the table in strategy and decisions," Dye says. "But without that full level of physician involvement, clinical integration efforts will be doomed from the start."

Whatever it takes. Sometimes, docs need to find their way as team players outside their offices, and go to the mountain – whether it's the Rockies or somewhere else.

As Paolini tells it, the physicians on her trip experienced "leadership education from the inside out," and ultimately, it "forced us to rely on each other."

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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